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07/i9/2016 TpE 11:�8 FAx Fa�t water xeater �003/005 <br />��Rnn�i� ap��.i�A��� � (� � b�t v ... <br />BUILDINGOME�Hq1y��qL/pLUfNRBI�IG/SIGN/SPl2��VF�L�F�/DEM�L.ITION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 Cedar St., Lverett, WA 98201 425-257-8810 FAX 425�257-8857 www.averettwa.org <br />131TEA�,DDRE33: � � p Op�g T�xr# D� i/� � P Mi # ��"I <br />rr �-� U '�" <br />LEGAI, for new con9tructlon: 9hart PIaU6ubdlvlslort Lot No, (atr�Ch copy of IonO Iega1 d�scrlptlon) <br />OWNER ��j�� L��S �� � � phon�lE-maU <br />� � 6�� � <br />CANT; � Owner ,� Owii9r'a Agent <br />ONTRACTOFi <br />Can�rHCtor <br />BUMLDING PERMIT APPLIC�ITION <br />� <br />���y,stara�Z�p ���v �I g� 3 , <br />CO�tfeC�Ot'8 F�qent � TBnant (muel provlde e IeHer ol cenaenl fmm (he awner m aa wor& �p tAe apece) <br />State Uc. # �/l��) €- � �,CIY Bus. �ic. ' <br />�l( <br />� . hhone/Emall �±'j �j 3 y'Vi l.f-� �,� � <br />CON'TACT FOf� PERMI'C ��,�., � <br />�'� ��!-k L� <br />Phone/�-msll �, <br />CONTRACT pRICE OF WORK <br />Exfating Use of Bullding � EAT SOURCE; <br />Proposed Use of � __ Gas Elactrlc <br />Bultding iype: Sin fo �amll , Duplex Townho . Multl-Famiiy _ Commercial <br />e of ro ect: New ,Additivn Ftemodel a T.I, 51 n S flnklror no,,,.,�:+:,.., ��.__ <br />DESCRI�PiION OF WORK (addlt/oRal sp�ce provlded on fhe bedc): <br />, <br />��CJv" �� �� t� � � <br />� <br />MECHA�IICAL PERMIT qPpLIC4T10N PLUM�1 <br />Type of proJect: �,NaW Addn "AIt�rAtlon _F�epalr Typa of proJecf: <br />&howNumber oitlxluras S oW <br />A/C -- a'rr hanrllir,n i inlfo <br />nanqe nood <br />Exhauat fan �- <br />Heat um <br />Unit heqtar <br />Boiler <br />R�fri er�tlon <br />W oodetovp <br />Ducilny <br />Other ' <br />SPRIN <br />��i-�.�r L�-�-��-- <br />NO PERMIT APpLICAT101N <br />� ddn Altaratlon _Rapair <br />Nu er # orllxturee <br />ilat <br />8a tu4 <br />Lav wash basin <br />Show r <br />Kltche sink & dls sal <br />�Ishwas er <br />Cfothes w s r <br />Weter he <br />Sink s Ice er/mo /etc. <br />Bac w reve er fnelde bfd <br />Ur sl <br />rinkin Fountaln <br />Floor drain <br />Greas� tra <br />Roof drains <br />Medical Gas <br />Other; <br />I hereby qenl�y lhat I h�ve roged e�d mxamined thls appllcatioh end know �ha seme �a be trUe g�d correct. All provfalong �f I�Wa and o1'd�hancea goV�rning lhle type Of warlc wlll be �mp <br />wlth whelhpr eDealFled hareln or nW, The granling of e permlt daaa np� prgsume �p glVe euth0��ly ta vlaletg Or canC61 tfle provl�len oF any olher gtaEe or local lew regulaling aonaiructbn <br />Thet I Am uthorl ed ey e ownnr oF lhle pro Ky perform Iha wpryt �yr whlch ApplfcaSlan Ig mede and 1 Oomply wltF1 Ehe 91a10 Contraatorg I.aw 79.27 IRCw and 286200A WAC. <br />- --1� <br />�w���rlp, orized Agent 91gnQtur� Dete <br />(aevlsvd d✓2o16J <br />